Attorneys General Ask Feds for Medicaid Investigation Policy Change

by Lacey Louwagie, Court House News, May 11, 2017

(CN) – Attorneys general from 38 states are asking the federal government for a policy change that would allow the states greater flexibility to investigate Medicaid fraud-related issues.

The letter to Tim Price, Secretary of the Department of Health and Human Services, urges the department to scrap the current limitations on the amount of federal funding that can go toward investigating abuse and neglect cases involving Medicaid recipients, especially those in home health care settings.

“Statistics cited by the Centers for Disease Control and Prevention (CDC) suggest that 1 in 10 persons age 65 and older who live at home will become a victim of abuse,” the May 10 letter says. “Not surprisingly, CDC figures also suggest that most elder abuse is never detected, with one study concluding that for every case of elder abuse that is detected or reported, 23 more remain hidden.”

Yet the current guidelines limit the usage of federal funds to investigate abuse and neglect cases in favor of allocating more funds to address Medicaid fraud.

The attorneys general call these guidelines “outdated,” adding that they “arbitrarily restrict our ability to protect Medicaid beneficiaries from abuse and neglect as Congress intended, and should be replaced or eliminated.”

To that end, the states are asking for two changes to current policy. First, they want the ability to use funds to investigate and prosecute abuse and neglect that occurs in non-institutional settings. They also want to use federal funds to review complaints that are submitted by Medicaid patients who are not in health care facilities.

“Better to err on the side of reviewing complaints or reports that ultimately are determined to involve conduct outside the scope the [Medicaid Fraud Control Unit] may investigate or prosecute than to err through narrow screening criteria that can leave abuse or neglect of Medicaid beneficiaries undetected by the MFCU,” the five-page letter argues.

“As a policy, states recognize the cost savings and health benefits of patients of shifting from institutionalized-based case to home health care,” Peter Kilmartin, Rhode Island’s attorney general, said in a statement. “The shift to home health care, however, has contributed to improper payments, significant fraud, and places vulnerable beneficiaries at risk for abuse and neglect.”

“We know you share our strongly held view that all persons should live free from abuse and neglect,” the letter concludes in a final appeal to Secretary Price. “The MFCUs are valuable assets to help make that freedom a reality for Medicaid beneficiaries.”

Led by President of the National Association of Attorneys General George Jepsen of Connecticut, attorneys general also signed on from Alaska, Arkansas, Arizona, Arkansas, Colorado, the District of Columbia, Hawaii, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, Wisconsin and Wyoming.